Ebola outbreak: How Canada's prep has 'led the world'

The Ebola virus continues to claim lives in West Africa, but the risk of it spreading to the Canadian public remains low, health experts say — and even if a case emerged here, the country is well prepared to handle it.

"I'm not concerned. I already know that Canada is prepared," said Jason Tetro, a microbiologist and author of The Germ Code, who recently penned the blog entry Canada, Don't Worry About Ebola in the Huffington Post.

"In truth, we've led the world when it comes to being prepared for these types of outbreaks."

The proof, Tetro said, is in how public health officials reacted to an Ebola scare back in March, when a Saskatchewan man returned from Liberia and later became ill.

He was immediately isolated and tested, while anyone he had been in contact with was notified and asked to assess themselves for a 21-day period. (He later tested negative.)

Public health reaction to the case "was exemplary," Tetro said. "We have a fully networked communication process that goes from the airline to Canada Border Services Agency to Public Health Agency of Canada to the individual health care facilities across the country."

Tetro said Canada's readiness can be credited to the SARS Commission, which made a number of recommendations following the outbreak of severe acute respiratory syndrome in Canada in 2003, including asking two key questions of travellers arriving in Canada who may be at risk.

"It's all based on two big issues: Where did you go, and what are you feeling right now?

"The symptomatology, which was the major thing that people would look at before, is actually secondary now to 'where were you.' And that's really the big shift."

Ebola not easily spread

Nearly 900 people have died in the current Ebola outbreak in West Africa. The cases of two American aid workers who contracted the virus in Liberia and were brought to Atlanta for treatment have fuelled concerns about the possibility of Ebola arriving in North America. 

But government public health officials have been trying to reassure Canadians they need not worry, reminding people that the virus doesn't spread easily through casual contact or the air, like the flu, and that one can only become infected though direct contact with infected bodily fluids.

In a recent statement, Health Minister Rona Ambrose stressed that all points of entry into Canada are routinely monitored, and travellers showing symptoms are referred to quarantine officers who have the authority to implement public health measures under the Quarantine Act to protect Canadians.

"So if you have travelled to a country where [Ebola] is known to be happening, when you get on a flight to come back to Canada, that flight is flagged and everybody inside is flagged," Tetro said. 

"When you arrive, if you have developed symptoms of the flu, they don't even ask, they put you right into quarantine. There are quarantine officers at every port of entry in to Canada," he said.

Those quarantine officers are "vigilant in their surveillance of travellers who are ill, including those showing signs of nausea, vomiting and diarrhea, or other indications of an infectious disease," Dr. Gregory Taylor, deputy chief public health officer at the Public Health Agency of Canada, said in a recent statement

Airlines and airports must report

Adding to the layers of scrutiny, airlines and airport authorities are required to report ill travellers arriving on international flights to quarantine officers, Taylor said.

Canadian hospitals also have sophisticated infection control systems and procedures in place that are designed to limit the spread of infection and protect health care workers, he added.

As well, health care professionals or other Canadian responders coming back from Ebola-stricken areas in West Africa are being asked to monitor themselves for symptoms for 21 days.

Jay Keystone, senior staff physician at Toronto General Hospital's tropical disease unit, recently told CBC News that Ebola could come to Canada and it's the first responders — the paramedics, emergency room doctors and other physicians — who he's most worried about it.

"Because if someone gets sick and they don't tell them that they've come from one of those areas, and someone doesn't ask, then you've got a problem," he said.

But the virus spreading to the general public is unlikely, he said.

"​We have excellent infection control.... We have isolation techniques with negative pressure rooms, excellent mask, gowns, etcetera. So the likelihood that it's going to spread here [is] extremely small. But it could come here."

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Experimental Ebola drug based on research from Canada's national lab

An experimental Ebola treatment given to two American aid workers infected in Liberia is meant to neutralize damage from the virus, says a Canadian scientist who works with Ebola and other pathogens.

To make the unlicensed drug, scientists injected mice with parts of the Ebola virus and then harvested the antibodies the animals produced to fight the virus. The drug, which hasn't yet been tested in humans, is grown in tobacco plants.

Researchers are also working on an experimental Ebola vaccine to prevent infection. But unlike a vaccine, the pre-clinical drug, called ZMapp, is designed to be given after exposure to the virus.

"It basically neutralizes the virus so it can't do any further damage," said Dr. Heinz Feldmann, chief of the U.S. National Institutes of Health's virology laboratory in Hamilton, Montana.

Feldmann previously oversaw the special pathogens program at the Public Health Agency of Canada's national microbiology lab in Winnipeg and is an expert in hemorrhagic fever viruses such as Ebola, as well as other viruses.

"It's a cocktail of antibodies," Feldmann said. "If you go through an infection as a human being or animal or get a vaccine, you will have an immune response to something foreign to your body. One response is using antibodies, a portion we call neutralizing antibodies."

Neutralizing antibodies attack the virus by interfering with its surface.

Research on the Ebola drug was jointly conducted in Canada and the U.S. The Canadian research was led by Dr. Gary Kobinger, who now heads the special pathogens research program at the national microbiology laboratory.

Kent Brantly, a physician who works with the relief organization Samaritan's Purse, was recently given ZMapp to treat his Ebola infection. Brantly, 33, contracted Ebola after treating Ebola patients at a missionary clinic in Liberia.

A second American aid worker, 58-year-old Nancy Writebol, was recently diagnosed with Ebola after working at a missionary clinic outside Liberia's capital, where she contributed to relief efforts by the aid group SIM USA.

Bruce Johnson, president of SIM USA, said Tuesday that while Writebol is still very weak, she is showing signs of improvement. 

Amber Brantly, the wife of Dr. Kent Brantly, thanked medical staff at Emory University Hospital in Atlanta, where he is now being treated.
 
"I have been able to see Kent every day, and he continues to improve," she said in a statement.

The Canadian research on an experimental Ebola treatment was done under the leadership of Dr. Gary Kobinger, who heads the special pathogens research program at the national laboratory in Winnipeg.

Some people infected with Ebola recover on their own or thanks to early, supportive medical care.

Tom Frieden, director of the U.S. Centers for Disease Control and Prevention, said experts can't be sure of the effect of an experimental drug such as ZMapp.

"Every medicine has risks and benefits," Frieden said. "Until we do a study, we don't know if it helps, if it hurts, or if it doesn't make any difference."

Feldmann said there is always a risk the first time that an experimental drug is given to humans, which is why countries are provided with the pre-clinical safety data and have strict regulations before granting permission.

The U.S. Food and Drug Administration said it cannot comment on the development of specific medical products.

"Currently, there are only experimental Ebola treatments in the earliest stages of development. Even though a drug is not approved right now, the FDA can still provide access to potential products through other mechanisms, such as through an emergency investigational new drug (IND) application," a spokeswoman said in an email.

The Public Health Agency of Canada said it was involved in the development of ZMapp, but the agency was not involved in the decisions to administer the treatment. 

The World Health Organization says that as of Aug. 1, there have been at least 1,603 cases of Ebola in the current outbreak, which is centred in Guinea, Sierra Leone and Liberia. At least 887 of those people have died.

As the American aid workers receive the experimental cocktail, three leading Ebola specialists are calling for experimental drugs and vaccines to be offered to people in West Africa as well.

The plea came Tuesday from Peter Piot, who co-discovered Ebola in 1976, David Heymann and Jeremy Farrar. They are, respectively, directors of the London School of Hygiene and Tropical Medicine, the Chatham House Centre on Global Health Security, and the Wellcome Trust.

"African governments should be allowed to make informed decisions about whether or not to use these products — for example to protect and treat health-care workers who run especially high risks of infection," they wrote.

They also called on the World Health Organization to take a greater leadership role to allow experimental treatments against Ebola.

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Toronto doctors remove teen's tumour without radiation or surgery

A Brampton, Ont., teenager has become the first pediatric patient in North America to have a benign tumour near his hip removed without radiation or surgery.

Doctors at the Hospital for Sick Children in Toronto used high-intensity focused ultrasound (HIFU) waves, guided by an MRI machine, to burn off the tumour of 16-year-old Jack Campanile two weeks ago.

The MRI pinpoints the tumour, which is then hit with heat-inducing ultrasound beams.

The operation came after a year of crippling pain for him.

"The only way I can describe it was if somebody was to kind of hit my leg with a sledgehammer over and over again," he told CBC News. 

Still, Campanile didn't like the idea of surgeons cutting into his bone to scrape away the tumour, so when the hospital offered him a chance to be the first person in North America to undergo a new non-invasive procedure, he jumped at the chance.

"I was very interested how it would work and how it wouldn't have an incision on the surface of the skin," he said.

The procedure took half a day. 

Campanile is now tumour-free.

"I can do jogging and hiking and stuff like that and it feels great because I don't have to do deal with the pain anymore," he said. The avid hockey player says once he gets the all clear from doctors in four weeks, he plans to lace up his skates.

Dr. James Drake, head of neurosurgery at the hospital, has been leading the research on HIFU.

The technology has been under development for three years and, in this case, spared Campanile the pain and risk of infection that comes with the standard treatment, which involves needles and lasers. 

"This is completely radiation free," Drake said. "We can use it as many times as we want … It's harmless to the surrounding tissues as long as it's correctly controlled." 

The treatment has also been used to treat uterine fibroids and certain bone tumours. Drake said researchers are also looking at possible uses in pediatric medicine. 

"We're very interested in treating other types of tumours, soft-tissue tumours that occur in the abdomen, and a number of applications in the brain where we think it might be useful, for example pediatric stroke and epilepsy," Drake said. 

"We think it's got a great future," Drake said. "Our expectation is this may become the standard treatment for a number of pediatric disorders." 

The hospital said it will continue its trials on nine other patients and expects to be able to target other tumours in about a year.

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Ebola death toll surpasses 930 as WHO emergency meeting convenes

Deaths from Ebola stand at 932 in four West African countries, the World Health Organization says Wednesday as it holds an emergency meeting to decide whether to declare the outbreak a global health emergency.

A total of 108 new cases and 45 deaths were reported between Aug. 2 and Aug. 4, the UN health agency said. Most of the newly reported deaths were in Liberia. In Nigeria, the number of cases increased from four to nine, including one previous death. Cases have also been seen in Sierra Leone and Guinea, where the outbreak originated.

At a two-day meeting, WHO officials are discussing how to contain the outbreak and whether to declare it a "public health emergency of international concern." Evidence of ongoing sustained human to human transmission is one of the key criteria that experts use to make the decision.

If so, it may entail border closures and even travels bans.

WHO said critical issues include:

• Cross-border infections and travellers.
• Stretched capacity and ability for partners to respond rapidly, safely and effectively.
• Socioeconomic impacts.

Volunteers lower a corpse, which is prepared with safe burial practices to ensure it does not pose a health risk to others and stop the chain of person-to-person transmission of Ebola, into a grave in Kailahun, Sierra Leone. (Tarik Jasarevic/WHO/Reuters)

Elsewhere on Wednesday, two American aid workers who contracted Ebola in Liberia appear to be improving after receiving an experimental medicine ahead of their evacuation back to the U.S. It's unknown whether the cocktail has helped.

In Saudi Arabia,  a 40-year-old man suspected to have contracted the Ebola virus after returning from Sierra Leone died , the country's health minister said. If confirmed, it would be the first Ebola-related death outside of Africa.

A Nigerian nurse who treated a man with Ebola died and five others are sick after coming in contract with him, a health official said. The death of the unidentified nurse is the country's second from Ebola.

In late July, Patrick Sawyer, a 40-year-old American of Liberian descent, flew from Liberia's capital to the Nigerian megacity of Lagos, introducing the virus there.

Experts say people infected with Ebola can spread the disease only through their bodily fluids and after they show symptoms.The incubation period can last up to 21 days.

Spain's Defence Ministry said Wednesday a medically equipped Airbus 310 is ready to fly to Liberia to repatriate Miguel Pajares, a Spanish missionary priest who has tested positive for the Ebola virus.

Pajares is one of three missionaries being kept in isolation at the San Jose de Monrovia Hospital in Liberia who has tested positive for the virus, Spain's San Juan de Dios hospital order, a Catholic humanitarian group that runs hospitals around the world, said Tuesday.

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Experimental Ebola drug based on research discoveries from Canada's national lab

Canadian research is at the heart of an experimental Ebola therapy recently given to two American aid workers infected while caring for patients in Liberia.

The unlicenced drug, called ZMapp, is made of three monoclonal antibodies, disease fighting proteins that target a specific part of an invading pathogen, in this case the Ebola Zaire virus. That is the specific strain of Ebola responsible for this outbreak.

Two of the monoclonal antibodies are the product of years of research done at the Public Health Agency of Canada's National Microbiology Laboratory in Winnipeg, the agency confirmed in an email late Monday.

The third was developed at the U.S. Army Medical Research Institute of Infectious Diseases, known as USAMRIID.

"Canada is a world leader in research and we are proud of the advances made at the NML (National Microbiology Laboratory) in this area," a spokesperson for the agency said via email Monday night.

The former head of the Winnipeg-based laboratory said he was delighted to hear that the Canadian-designed monoclonal antibodies had been used in this way.

"This is really gratifying to see the work come to fruition," said Dr. Frank Plummer, who stepped down as the lab's scientific director at the end of March.

"It's a big achievement after years and years of very hard work."

The Canadian research was done under the leadership of Dr. Gary Kobinger who heads the special pathogens research program at the national laboratory. His team had developed a cocktail of three monoclonal antibodies called ZMAb, the rights to which were recently acquired by LeafBio of San Diego, Calif.

LeafBio is collaborating with Mapp Biopharmaceutical, also of San Diego, which is the maker of ZMapp. That is the product given last week to Dr. Kent Brantly, who works with the relief organization Samaritan's Purse, and Nancy Writebol, an American missionary who works with the organization Service in Mission or SIM.

The two were infected while working at an Ebola treatment centre in Liberia. Brantly was transferred to the United States last weekend, where he was admitted to a special isolation treatment unit at Emory University Hospital in Atlanta. Writebol is also being brought back to the United States; she is to arrive at Emory on Tuesday.

Drug generated in tobacco plants

Neither ZMapp nor the individual monoclonal antibodies it contains have been tested in humans, though small studies in non-human primates look very promising. It has been reported that Brantly and Writebol were warned the drug had only been tested in animals but that they were willing to try the treatment anyway.

A joint statement from Mapp Biopharmaceutical and LeafBio said ZMapp is an optimized monoclonal cocktail, incorporating the best of the Canadian and U.S.-made antibodies.

The drug is generated in tobacco plants that have been genetically engineered to produce the monoclonal antibodies. That work is done by Kentucky BioProcessing of Owensboro, KY., a subsidiary of tobacco giant Reynolds American.

A spokesman for Reynolds said within the last week Kentucky BioProcessing was asked by Emory University Hospital and Samaritan's Purse to provide a limited amount of ZMapp to be used to treat Brantly and Writebol. David Howard said the makers were given an IND — investigational new drug — designation by the U.S. Food and Drug Administration.

He said the drug's makers hope to begin a Phase I clinical trial later this year. That type of preliminary trial involves giving a therapy to healthy volunteers to see if it is safe for people to take, and to determine an appropriate dose. These studies are not large enough to provide proof of whether a drug works.

The Canadian lab is one of the leading research facilities globally for countermeasures for Ebola and Marburg, a related virus which also causes severe and often fatal infections.

Winnipeg drug tested on exposed animals

An experimental Ebola vaccine made at the Winnipeg lab under Kobinger's predecessor, Heinz Feldmann — now head of the virology laboratory at the U.S. National Institute of Allergy and Infectious Diseases' Rocky Mountain Laboratories in Hamilton, Mont. — is considered the best candidate vaccine for Ebola.

Unlike other experimental Ebola vaccines, the one designed at Winnipeg appears to work if given shortly after exposure to the virus, at least in animal testing. If it can be pushed through the developmental pipeline, it could be the option of choice for researchers who risk getting infected when working on Ebola in laboratories and health-care workers who can become exposed during outbreaks.

The Winnipeg lab and a number of other facilities have been working for years to produce Ebola and Marburg interventions. But lack of funding and regulatory hurdles had prevented these experimental tools from being used in outbreaks up until now.

Still, this emergency use is unlikely to change the course of the current outbreak, which continues to infect people in Guinea, Sierra Leone and Liberia and now may be moving into Nigeria. That country reported several suspect and probable cases Monday, at least two of whom are health-care workers who treated an infected man who recently travelled by plane to Nigeria from Liberia.

While there are a number of experimental therapies in development, there may be only small quantities of each available. Research laboratories and small biotech companies typically would make only what they need for research purposes. Ramping up production of a drug or a vaccine only happens when it has been licenced and the manufacturer is ready to take it to market.

The World Health Organization says that as of Aug. 1 there have been at least 1,603 cases of Ebola in this outbreak and at least 887 deaths.

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Ultra-endurance sport training can hurt your heart health

Video

CBC's Kim Brunhuber reports on the hardcore athletes who push heart health to the extreme

CBC News Posted: Aug 04, 2014 11:04 PM ET Last Updated: Aug 04, 2014 11:04 PM ET

There are currently a record number of middle-aged Canadians taking part in high endurance sports, like ultra-marathons and long-distance cycling.

Training for these kinds of events, however, often results in long-term physiological changes for athletes, and new research suggests that some of these changes can be unhealthy – even dangerous.

About five per cent of middle-aged people who significantly exceed the recommended 150 minutes of weekly exercise experience side effects such as irregular heart rhythm, which can lead to blood clots and strokes.

Interestingly, conditions related to ultra-endurance training appear to be more common among men.

Check out the report from CBC's Kim Brunhuber to learn more about the athletic craze gaining popularity across the country, and what it means for athletes' bodies.

Comments on this story are moderated according to our Submission Guidelines. Comments are welcome while open. We reserve the right to close comments at any time.

Submission Policy

Note: The CBC does not necessarily endorse any of the views posted. By submitting your comments, you acknowledge that CBC has the right to reproduce, broadcast and publicize those comments or any part thereof in any manner whatsoever. Please note that comments are moderated and published according to our submission guidelines.

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Firefighter's family links suicide to PTSD, files for workers' compensation

At the end of July, 38-year-old Edmonton firefighter Brad Symes took his life, leaving behind his wife of seven months, two young boys, loving parents and countless friends — and his family is linking his death to post-traumatic stress disorder (PTSD).     

Symes was a firefighter for 13 years, following in his father's footsteps.

Stan Symes retired as the district fire chief in Edmonton after 35 years on the job. While he worked as a first responder, he found it helpful to confide in his wife, Char. 

Brad Symes often called his parents to talk about his job and the things he witnessed.

"Lots of times he would just call and say, 'Mom, this is what happened today,'" Char said. "He has two little children and that's hard for any parent. You think of your own kids, and you want to hug them more and love them more."

But Stan Symes remembers one phone call in particular.

"He went to a call at O'Leary Pool and a little guy had drowned," Stan said. "He was upset. He related it to his boys. It's just, you have to talk about it."

The Symes believe that traumatic incident may have been a turning point in their son's life.

Brad Symes was never officially diagnosed with PTSD. His parents said there were no overt signs of his mental-health issues. His family has now filed a claim for workers' compensation, but will have to prove he suffered from the disorder.

PTSD legislation

The suicide of the veteran firefighter has again raised the issue of PTSD among first responders.

Edmonton firefighter Brad Symes left behind two children, a wife, parents and close friends when he committed suicide. His family is linking his death to post-traumatic stress disorder. (CBC News)

Alberta passed legislation in late 2012 that says first responders diagnosed with PTSD do not have to prove if the illness was job-related in order to get workers' compensation.

Since the legislation was enacted, 36 claims have been filed — 17 by paramedics, 11 by firefighters and eight by police officers. Thirty-two of those claims have been accepted.

Stan and Char Symes were shocked by their son Brad's suicide. They hope telling his story will raise awareness about post-traumatic stress disorder among first responders. (CBC News)

Vince Savoia, founder of the organization Heroes are Human, said he's surprised the number of people filing claims is so low.

"I need to wonder if many of the first responders are fearful of coming forward," he said.

Savoia calls it the "John Wayne" syndrome — those who help people won't ask for help when they need it themselves.

"It's seen as a sign of weakness, when in fact it should be seen as a sign of strength."

Stan Symes admits that was often the mentality while he was a firefighter.

"You could never show a weakness," he said. "We were the ones that were coming to you and you just had to show that front. It hurt a lot of people because of that."

While he was district fire chief, he said he asked his firefighters to talk to each other whenever they felt stressed.

"We have to figure out ways on how to deal with it," Stan Symes said. "I know that if it's happened to our son, Char and I are going to be right at the front, trying to fight against this illness."

Removing the stigma

Edmonton firefighters were shocked to learn of the death of their caring co-worker.

Greg Holubowich, president of the union representing firefighters, said Brad's suicide has had an incredible impact on his members.

"What could we have done differently? How could we have helped Brad in this obviously dark time in his life?" he said. "I think we can gather strength by taking this tragedy, this negative, and ensure we have open lines of communication in the future."

Edmonton fire Chief Ken Block said he wants to ensure that first responders facing mental-health issues seek help.

"We need to really commit ourselves to what's happened in Brad's situation and not allow it to pass and be forgotten," Block said.

"In many ways, that's part of our challenge moving forward, changing the perception and that stigma that may go along with mental-health challenges that all of us experience from time to time."

'How many more?'

Char Symes describes her son as "an honest, good-hearted, loving dad."

Hundreds of first responders attended Brad's funeral, which Block said was the largest one for a firefighter that he had ever seen.

"I think he had a really good life to touch so many people, and to have so many friends and be able to do so many things in his lifetime," Char Symes said.

Savoia's organization says 15 Canadian first responders have committed suicide in the past few months.

"Our son was No. 16," said Char. "How many more do we really want this to happen to?"

"We don't want to see or hear about No. 17," said Stan Symes. "We want it to stop."

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Ebola: 2nd patient arrives in U.S. for more treatment

Updated

Nancy Writebol in serious but stable condition

The Associated Press Posted: Aug 05, 2014 6:25 AM ET Last Updated: Aug 05, 2014 11:40 AM ET

'We need to stop Ebola everywhere': WHO 6:31

'We need to stop Ebola everywhere': WHO 6:31

Doctor wants Ebola vaccine fast-tracked 4:51

Doctor wants Ebola vaccine fast-tracked 4:51

The second American aid worker who was recently diagnosed with Ebola in West Africa has arrived in the U.S. for treatment.

The patient arrived in a specially equipped jet at Dobbins Air Reserve Base in Marietta, Georgia, late Tuesday morning. She will be taken to an isolated unit at Emory University Hospital for treatment.

Nancy Writebol, shown with children in Liberia, is one of two Americans working for a missionary group in Liberia that have been diagnosed with Ebola. (Jeremy Writebol/Associated Press)

Although hospital officials haven't released the patient's identity, the aid group she was working with has identified her as 59-year-old Nancy Writebol.

SIM says in a statement that Writebol remains in serious but stable condition.

Dr. Kent Brantly, a physician with North Carolina-based Samaritan's Purse, arrived in Atlanta for treatment Saturday. Both contracted Ebola while treating patients in Liberia.

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Fentanyl mix-up believed responsible for Abbotsford overdose

Authorities in B.C.'s Fraser Valley are still concerned that drug users are taking the synthetic opioid painkiller fentanyl while under the impression they are using heroin or oxycodone.

Abbotsford police say that officers found a bag of white, powdered fentanyl near the scene of an overdose in the 2100 block of Peardonville Road.

A 38-year-old man was found at that location in his trailer home in severe medical distress Friday. He was rushed to hospital, where he died.

Police say the man did not appear to be aware he was taking the substance in its pure form. 

Fentanyl, a potent synthetic opioid, poses dangers because of its rapid absorption into the human body.

Last year, police in Abbotsford warned drug users after a number of heroin overdoses occurred in which it appeared fentanyl had been mixed into the heroin, unbeknownst to the users.

In June, after fentanyl was linked to the deaths of 13 people in the Fraser Health region already this year, the BC Coroners Service issued a public warning. In 2013, there were 12 deaths linked to fentanyl in the Fraser Health region, and 2012 saw six.

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Australia may intervene in case of abandoned baby with Down syndrome

Australia's government is considering intervening in the case of a sick Down syndrome baby left with a Thai surrogate mother by Australian biological parents.

Pattaramon Chanbua, a 21-year-old food vendor in Thailand's seaside town of Sri Racha, is taking care of her 7-month-old surrogate baby, named Gammy, who also has a congenital heart condition. The parents, who have not been identified in the media, took Gammy's healthy twin sister back to their home in Western Australia state.

Australian Immigration Minister Scott Morrison told Sydney Radio 2GB on Monday that Pattaramon "is an absolute hero" and "a saint," adding that the law surrounding the case "is very, very murky."

"We are taking a close look at what can be done here, but I wouldn't want to raise any false hopes or expectations," Morrison said. "We are dealing with something that has happened in another country's jurisdiction."

Morrison's spokesman Julian Leembruggen later declined to say what type of intervention the government was considering.

In Sri Racha on Sunday, Pattaramon said that she was not angry with the biological parents for leaving Gammy behind, and that she hoped they would take care of the boy's twin sister they took with them.

"I've never felt angry at them or hated them. I'm always willing to forgive them," Pattaramon told The Associated Press. "I want to see that they love the baby girl as much as my family loves Gammy. I want her to be well taken care of."

Surrogate still unpaid by agency

Pattaramon was promised $9,300 by a surrogacy agency in Bangkok, Thailand's capital, to be a surrogate for the Australian couple, but she has not been fully paid since the children were born last December.

She said the agency knew about Gammy's condition four to five months after she became pregnant but did not tell her. It wasn't until the seventh month of her pregnancy when the doctors and the agency told her that one of the twin babies had Down syndrome and suggested that she have an abortion just for him.

Pattaramon recalled strongly rejecting the idea, believing that having the abortion would be sinful. "I asked them, 'Are you still humans?' I really wanted to know," she said.

An online campaign by the Australian charity organization Hands Across the Water to help Gammy has raised around $200,000 since July 22.

Child 'should be an Australian citizen'

Mora Kelly, founder of the Children First Foundation, which brings sick children from developing countries to Australia for medical treatment, said she had discussed with Hands Across the Water bringing Gammy to the Australian city of Melbourne for heart surgery.

"I believe that this child should be able to access our health care system here in Australia," Kelly told Australian Broadcasting Corp. "This child, in essence ... should be an Australian citizen."

Hands Across the Water founder Peter Baines was not immediately available for comment Monday.

ABC also reported that Gammy's biological father denied intentionally abandoning his son in Thailand, and that he had not known that his new daughter had a twin.

It is illegal to pay a surrogate mother in Australia and in some states, excluding Western Australia, it is also illegal to pay a surrogate living overseas. An Australian woman can act as a surrogate for free, but also has a right to keep the child rather than hand it over to the biological parents.

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